Draft future models of care for health services in south west London are set out in six clinical reports published today by the Better Services Better Value review. The reports, drawn up by teams of local doctors, nurses and other health professionals, build on the case for change by setting out in detail the challenges facing local health services. They have been influenced by local people, patient groups and stakeholders, who have been involved in the review from the beginning. The six reports cover urgent and emergency care, maternity, children’s services, long term conditions, planned care and end of life care.
Dr Howard Freeman, local GP and Joint Medical Director for NHS South West London, said:
“We are publishing these draft reports because we want this review to be transparent at every stage. Local people have a right to see the evidence that clinicians have been discussing as we look to improve local health services, make the best use of skilled health professionals and get better value for the £2.3 billion we spend on healthcare in south west London every year.
“The draft reports are open and honest about the quality of current services and where they need to improve. They set out the evidence and suggest new models of care - recommendations of how services could be delivered in the future. They are based on the needs of our local population, but they are not yet location-specific – we have no blueprint for where each service should be located.
“No decisions have been made yet. These are working clinical papers, they are not final and we are publishing them for discussion, prior to producing final versions in early 2012.”
Dr David Finch, local GP and Joint Medical Director for NHS South West London, added:
“The population is changing - increasingly people are living past the age of 85 but they are usually much sicker as they have long term illnesses like diabetes or breathing problems. These people use health services the most – they account for over half of GP visits, and one in three hospital beds and are often admitted via A&E.. Our current NHS is not designed in the right way to treat people with long term illnesses in their homes and in the community to keep them well and out of hospital.
“Changing the way we deliver services will save lives. A recent study into acute medicine and emergency surgery showed that over 500 deaths could be avoided* if the death rate for patients admitted at the weekend was the same as the death rate for patients admitted during the week.
“This is the latest stage in a detailed review. These are not formal consultation documents, but we do welcome comments. The clinical working groups will meet again in January to consider feedback received. Local doctors and nurses leading the review are eager to get out and talk to local people and organisations to discuss local health services and why they need to change. Between May and December, we will have attended over 100 meetings with clinicians and in the local community. We will continue to talk to local people every step of the way – and we will formally consult the public next year on detailed proposals to improve health services in south west London.”
Among the issues highlighted in the clinicians’ draft reports are:
Urgent and emergency care draft report:
- A&E should be open 24 hours a day and 7 days a week, requiring senior doctor presence for 16 hours each day to meet minimum guidelines from the College of Emergency Medicine. Three out of four hospitals in south west London do not currently meet this standard.
- To meet this standard would require more senior doctors in fewer A&Es or a major recruitment drive for senior consultants.
- A large proportion of people who attend A&E could be more appropriately treated elsewhere, for example in an urgent care centre. Local doctors and nurses recommend having an urgent care centre attached to all A&Es, integrated with other services such as out of hours GPs and community services**.
Maternity draft report:
- There are not enough senior doctors present during childbirth. To meet recommended levels of senior doctor presence, the most likely sustainable solution for south west London is to switch from four to three maternity units. An alternative would be to provide different levels of service at existing maternity units.
- There is not enough one-to-one midwife care during childbirth. Evidence suggests one-to-one care has a positive impact on the health and wellbeing of mother and child. There is a national shortage of trained midwives and recruiting and retaining midwives is a challenge that is increasing as the birth rate rises.
Planned care draft report:
- Too many operations are cancelled due to theatre time being needed to deal with emergencies – planned surgery should be ring-fenced to avoid such disruption
- More cases can be done on day care basis requiring no overnight hospital stay, due to advances in surgical techniques, drugs and equipment
- Operations could in future be carried out in specialist planned surgery centres for which existing sites could be used
Children’s services draft report:
- Each year, more children and young people go to A&E for minor illnesses which could be dealt with by GPs and other health professionals in the community or at urgent care centres attached to A&E or in the community
- There is a shortage of doctors with the specialist skills needed to care for children and young people who are very ill
- Short-stay Paediatric Assessment Units for children should be linked to every children’s A&E.
- Longer-stay hospital beds for very sick children could be located in specialist units.
Long term conditions draft report:
- Many more people will be living with long term conditions such as asthma, diabetes and respiratory problems over the next ten years. People with long term conditions are the most intensive users of health services, accounting for over half of all GP visits.
- Better treatment in the community, better co-ordination and planning and supporting patients and carers to become experts in their own condition are among the key solutions put forward to reduce unnecessary hospital attendances and support people to manage their long term conditions better and prevent problems arising where possible
End of life care draft report:
- Not enough people die in the location of their choice and too many people die in hospital when better end of life care could be provided elsewhere
- Better co-ordination is needed between services and a single end of life care register, stating people’s preferences, should be implemented across health and social care services in south west London.
The clinical working groups will be meeting in January to discuss all of the feedback they have received to date. More recent feedback from patients, the public and stakeholders will be discussed by the clinical working groups as they work to finalise the clinical reports early in 2012. At the same time, the clinicians leading the review will be engaging with local people and stakeholders to get their views on some broad ‘criteria’ that decision-makers should take account of when assessing options for service change and to explore which of these criteria are most important to them and why.
The deadline for submitting feedback on the draft clinical reports is midday on Tuesday 10th January 2012. Please submit feedback to:
betterservices@swlondon.nhs.uk
or
Better Services Better Value
Communications & Engagement
5th Floor
120 The Broadway
Wimbledon
London
SW19 1RH
- For more information on Better Services Better Value, and to read the clinical reports and case for change, go to www.southwestlondon.nhs.uk For more information or to get involved in the Better Services Better Value review:
- Twitter: @nhsswlondon #BSBV
- Facebook: www.facebook.com/BetterServicesBetterValue
- Email: betterservices@swlondon.nhs.uk
- Phone: 020 3458 5747
- Website: www.southwestlondon.nhs.uk
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- Notes to editors -
For further information contact: Rory Hegarty 020 3458 5926 / 07919 302708 email rory.hegarty@swlondon.nhs.uk or Holly Wild 020 8251 0512. Email holly.wild@swlondon.nhs.uk
*Review of London acute medicine and emergency general surgery services
Report setting out the need for change in hospital care for emergency patients and new clinical standards has been published by NHS London and London Health Programmes. Evidence put forward by leading clinicians suggests that increasing the number of hours hospital consultants are available at weekends and improving access to diagnostic scans could save more than 500 lives every year in London. More than half a million patients are admitted to a London hospital as an emergency every year. They should expect to receive consistently safe, high quality care. However, new figures show that patients admitted at the weekend have a significantly increased risk of dying compared to those admitted on a weekday.
** To clarify what we mean by each of these services:
· An urgent care centre is primarily used to treat patients who have an injury or illness that requires immediate care but is not a medical emergency. Urgent care centres are usually GP-led.
· An A&E is the Accident and Emergency departments of hospitals, that assess and treat people with serious injuries and those in need of emergency treatment.
· Out of hours GP services are services provided by local GPs outside their normal hours.
· Community services are local health services provided outside a hospital. Many community staff are attached to GP practices and to health centres.
· Clinicians from across health organisations in South West London are working together on the Better Services Better Value review. The organisations involved are:
- Croydon Health Services NHS Trust
- Epsom and St Helier University Hospitals Trust
- Kingston Hospital NHS Trust
- St George's Healthcare NHS Trust
- Hounslow and Richmond Community Healthcare NHS Trust
- The Royal Marsden NHS Foundation Trust
- Your Healthcare
- South London & Maudsley NHS Foundation Trust
- West Middlesex University Hospital NHS Trust
- South West London and St George's Mental Health NHS Trust
- The seven emerging GP consortia across south west London
- NHS South West London, including Croydon, Kingston, Merton, Sutton, Richmond and Wandsworth
· The review is looking at six clinical areas:
- Planned care
- End of life care
- Urgent, unscheduled and emergency care
- Maternity and newborn care
- Children’s services
- Long term conditions